"Hospital trends from NZHIS data, 1988-2001:
what implications for the health management task?"
Presented by
Peter Davis, Ph.D.
Professor of Public Health
Christchurch School of Medicine and Health Sciences

At this first meeting for the year, 25 of us enjoyed the hospitality of the Botanic Gardens Cafe (thanks to Eurest for providing the venue) as we settled in to the presentations.

For the main topic we were delighted to have Professor Peter Davis present "Hospital trends from NZHIS data, 1988-2001: what implications for the health management task?".

Peter and colleagues have been interrogating the NZHIS data from 1988 to
2001 to look at the changes in hospital care and the effects on access for disadvantaged groups and the outcomes for patients. This was prompted by a first look at the data which showed that from 1988 to 2001 the beds utilised in the 32 hospitals studied dropped from by about 40% while the number of discharges increased by around 75%. (see attached graph) In this fascinating presentation he also looked at how these trends had varied with the four different health structures (AHB, CHE, HHS, DHB).

In summary:

• Supply: marked reduction in bed numbers

• Care: % day stay up, bed days down, readmissions up

• Activity: overall levels of access and patient throughput maintained

• Access: maintained for vulnerable groups

• Quality: declining post-admission death rates, but higher levels of readmission

• Regime: notable features of trends seem to be a function of phase rather than regime type

A lively discussion ensued with reminiscences from some of those present who had worked through this time of massive change.

The information confirmed that since 1988 the public hospital sector of the NZ health system has become dramatically more efficient (at least judged as according to the use of inpatient beds as a measure of the application of hospital resources) with no drop off in the quality of outcome for patients or access to care for vulnerable groups - a story that is never told.

Before Peter presented we began with the presentation of Fellowship of the ACHSE to Professor Laurence Malcolm. Laurence spoke briefly outlining four positives in the New Zealand Health system as he saw it:

Evidence from recent New Zealand and international studies indicate that New Zealand is ahead of the rest of the world in the following:

• Developing a successful partnership between managers and clinical directors, a key factor in building a better quality more efficient health system.

• Developing a quality culture with major improvements in both primary and secondary care driven by clinical leaders and managers within DHBs and primary care/primary health organisations.

• Building a more integrated primary health care system through PHO which are expected by the end of this year to cover some 90% of the population, with emerging accountability for both quality and financial management of primary care resources.

• Developing an integrated health system through DHBs especially the integration of primary and secondary care with major implications for promoting continuity of care and reducing demands upon hospital-based services.

It was delightful to have confirmation that good things have been happening in the New Zealand health system and that whatever crises we face, progress is being made in crucial areas.

Regards
Michael Aitken FCHSE
National Councillor

This event was made possible by the generous support of